What is Guaranteed Issue for Medicare Supplement Plans?

  • Medicare Supplement, AKA "Medigap" policies are available in standardized benefit plans, identified by certain letters between A and N (however, different plans are offered in MA, MN, and WI). 
  • Turning age 65 and signing up for Part B triggers a six-month Medigap open enrollment period when Medigap insurers must issue you a policy, regardless of pre-existing conditions. This is called a guaranteed issue right. 
  • In certain limited instances, leaving a Medicare Advantage plan may trigger a guaranteed issue right. Some states have additional guaranteed issue periods for Medicare beneficiaries. Agents should look into state-specific Medigap laws. 

Newly eligible individuals may not enroll in Medigap that pays Part B deductible (plans C and F). Newly eligible individuals are defined as those who have attained age 65 on or after Jan 1, 2020 or first become eligible for Medicare due to age, disability, or end-stage renal disease on or after Jan 1, 2020. 

Below are the Guaranteed Issue Scenarios:

Guaranteed Issue #1

You have a Medicare Advantage Plan (HMO/PPO) & your plan is being discontinued or you move out of the plan’s service area. GI is good for 60 days before the plan termination and 63 days following the plan termination. Current Medicare Supplement clients that move from one state to another do NOT have a GI period. 

Guaranteed Issue #2 

You have Medicare and an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare and that plan is involuntarily ending. GI is good for 63 days after the plan termination date. In CA, both voluntary and involuntary termination apply. 

Guaranteed Issue #3

You have Original Medicare Select policy. You move out of the Medicare Select policy’s service area. 

  • You can keep your Medicare Supplement insurance policy, or you may want to switch to another Medicare Supplement insurance policy. 
  • GI is good for 60 days before the plan termination and 63 days following the plan termination. 

Guaranteed Issue #4 

(Trial Right) You joined a Medicare Advantage Plan (like an HMO or PPO) or Programs of All-inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at 65, and within the first year of joining, you decide you want to switch to Original Medicare. GI is only good for 12 months following Part A effective date (regardless of MAPD effective date). Client that delays Part B may not be able to utilize this Guaranteed Issue (GI). The advice is to tell clients to delay BOTH A and B so they can use this GI. 

Guaranteed Issue #5 

(Trial Right) You dropped a Medicare Supplement insurance policy to join a Medicare Advantage Plan (or to switch to a Medicare Select policy) for the first time; you have been in the plan less than a year, and you want to switch back. GI is good for 12 months from the MAPD effective date. If the original MS plan is still offered must go back to that plan/carrier. If it is not available, GI for any carrier. 

Guaranteed Issue #6, 7, and 8 (CA-SPECIFIC STATE GUIDELINES FROM HERE)

#6 Your Medicare Supplement insurance company goes bankrupt, and you lose your coverage, or your Medicare Supplement insurance policy coverage otherwise ends through no fault of your own. 

#7 You leave a Medicare Advantage Plan or drop a Medicare Supplement insurance policy because the company hasn’t followed the rules, or it misled you. 

#8You enroll in a Medicare Part D plan during the initial enrollment period, and at the time you are enrolled in a Medicare Supplement insurance policy that covers outpatient prescription drugs. You enroll into a Medicare Supplement insurance policy without outpatient prescription drug coverage. GI is good for 63 days after the plan termination date. 

Guaranteed Issue #9

Birthday Rule: Based on your date of birth, you can choose to change your existing Medicare Supplement plan. You can choose a plan with the same or fewer benefits as your existing plan from any company. 

GI is good for 60 days from the member’s date of birth (used to be 30 days). Clients can move to a plan of equal or lesser value. That now means client can move between plan F

Guaranteed Issue #10

Employee Welfare Benefit plan Terminates or Changes: You are enrolled under a employee welfare benefit plan that provides health benefits that supplement the benefits under Medicare and the plan terminates, stops providing supplemental benefits to Medicare or stops paying the Medicare Part B 20% coinsurance. GI is good for 63 days after the plan termination date. 

Guaranteed Issue #11

11A: Your MA plan increased your premium or copayments, reduced your benefits, or terminated its relationship with your medical provider for reasons other than good cause, relating to quality of care of who was treating you. 

11B: If the MA plan you belong to doesn’t sell a Medicare Supplement insurance policy, you still have the right to buy a Medicare Supplement plan from any other company if the MA plan: (i) increased your premium or copayments by 15% or more, (ii) reduced your benefits, (iii) or terminated their relationship with your medical provider for reasons other than good cause relating to quality of care who was treating you. Can only use during AEP and OEP. If using 1B we need proof of the changes from the other carrier (ANOC letter will suffice). Plan Selection is dependent on original Medicare Eligibly Date. Submit the Medicare Supplement Application & receive confirmation of enrollment BEFORE enrolling the PDP plan. 

Guaranteed Issue #12

You lose eligibility for full Medicaid or MediCal benefits due to an increase in income or assets and return to Original Medicare. GI is good for 6 months from the loss of Full Medi-Cal (proof required). Must be due to changes in assets- not due to not completing paperwork. 

Guaranteed Issue #13 and 14

#13 Military: Health care services are terminated for a military retiree, or the retiree’s Medicare eligible spouse or dependent, as a result of a military base closure, or loss of access to health care services because the base no longer offers services, or because the individual relocates. 

#14 Divorce or Death of Spouse: Loss of eligibility due to divorce or death of spouse from any employer-sponsored health plan (including retiree, COBRA or Cal-COBRA). GI is good for 6 moths from the loss (proof required). 

To find the best Medicare Advantage or Medicare Supplement plan that is right for you, please do not hesitate to give us a call. You can also schedule a meeting by using this link.

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Sep 27, 2023